Comparison of the 3 Most Commonly Used Modified PD-1 Inhibitors Plus Chemotherapy in Inoperable Wild-Type Non-Small Cell Lung Cancer.

[OBJECTIVE] Immunotherapy combined with chemotherapy is a standard treatment for advanced non-small cell lung cancer (NSCLC). However, the comparative efficacy and safety of cost-efficient modified PD-1 inhibitors remain incompletely characterized. This study aimed to determine the optimal choice for the 3 most commonly used modified PD-1 inhibitors-tislelizumab, sintilimab, and camrelizumab-combined with chemotherapy in locally advanced or metastatic NSCLC.

[MATERIALS AND METHODS] We conducted a retrospective study of patients with NSCLC who received chemotherapy plus 1 of the modified PD-1 inhibitors. The primary objective was to compare survival and therapeutic responses across groups. The secondary objective was to analyze adverse events in each group.

[RESULTS] No significant differences were observed in median progression-free survival (PFS) or overall survival across the 3 groups. However, PD-L1-positive patients (tumor proportion score ≥ 1%) demonstrated significantly prolonged PFS with tislelizumab ( P =  .038) and sintilimab ( P =  .031) vs camrelizumab. The incidence of immune-related adverse events did not differ statistically across treatments.

[CONCLUSION] Although survival outcomes were comparable among the 3 PD-1 inhibitors in the overall cohort, tislelizumab and sintilimab showed superior PFS in PD-L1-positive subgroups, suggesting biomarker-driven therapeutic selection. These findings underscore the importance of PD-L1 status in optimizing immunotherapy regimens for advanced NSCLC, offering clinical insights for personalized treatment strategies.